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The latest Inner Circle webinar recording on the Strategies for Anterior Pelvic Tilt is now available.

Updated Strategies for Anterior Pelvic Tilt

This month’s Inner Circle webinar was on Strategies for Anterior Pelvic Tilt. This is actually an update on one of my most popular webinars in the past. I am doing a couple new things and wanted to assure everyone has my newest thoughts. In this webinar I go through my system of how I integrate manual therapy, self-myofascial release, stretching, and correcting exercises. To me, it’s all how you put the program together. My system builds off each step to maximize the effectiveness of your programs.

I wanted to share an exercise I have been incorporating into my programs lately to develop posterior shoulder strength, endurance, and overhead stability. I call it the ER Press as it combines shoulder external rotation in an abducted position with an overhead press. When performed with exercise tubing, it provides an anterior force that the posterior musculature must resist during the movement. The key is to resist the pull of the band while you press overhead.

I use this drill a lot with my baseball players and overhead athletes. I think it’s a great drill that hits many of the areas that I focus on when training a strong posterior chain of the trunk and arm.

It’s also becoming a favorite of my Crossfit and olympic lifting athletes, who are reporting that they feel more comfortable overhead and have more stability with their snatches and overhead squats.

There are numerous progressions that can be performed by simply changing the position the athlete is in, including tall kneeling, half kneel, and split squat stances. You can also perform some rhythmic stabilizations at the top range of motion once to increase the challenge.

My latest educational program with Eric Cressey, Functional Stability Training for the Upper Body, is now available!

FST for the Upper Body is the third program in out Functional Stability Training system, adding to the popular Core and Lower Body programs. When Eric and I started to brainstorm what we wanted to teach with these programs, we wanted to share our approaches to rehabilitation and performance training, but more importantly how we integrate the two together. This makes the FST products a great resource for any rehabilitation, fitness, or performance specialist.

Functional Stability Training for the Upper Body

In order to function properly, our body needs to be strong and mobile, but control and stabilization of this mobility is often less than optimal. Unfortunately, stabilization is often overlooked in the design of rehabilitation and performance programs. Traditional program design relies too much on mobilizing what is tight and strengthening what is weak. We are missing the boat on stabilization and it’s effect on enhancing optimal movement patterns.

Proper function of the upper extremities is complicated and requires the arm to work in conjunction with the scapula, thorax, cervical spine, and core to provide mobility, strength, and power to the entire body. Any deficits in stability throughout the body’s kinetic chain can lead to injury, dysfunction, and a decrease in performance in the upper body. FST for the Upper Body aims to help formulate rehabilitation and training programs designed to optimize how the upper body functions.

The answer to all of these questions is ABSOLUTELY! Functional Stability Training for the Upper Body discusses all this and more, showing you exactly how you can assess and correct issues within the kinetic chain to optimize stability and performance of the upper extremity.

Here is an outline of the presentations and lab demonstrations that we perform. Eric and I combine presentations with real life examples so you can see how we both manage specific individuals based on our assessments. You get to see Eric and I at work together working with people:

How posture and position influence upper extremity function

Understanding and managing joint hypermobility

Understanding the elbow: functional anatomy, common injuries, and conditions

Elbow injuries: evaluation and management

Assessment and management of thoracic mobility restrictions

Assessment and management of muscles imbalances of the shoulder and scapula

Assessment and management of scapular position

Assessment and management of elbow epicondylitis

Optimal Shoulder Performance

For those that are familiar with Eric and I’s other education program Optimal Shoulder Performance, Functional Stability Training for the Upper Body takes this information to the next level by showing how we integrate the entire body to optimize upper body function.

FST for the Upper Body integrates the concepts learned from FST for the Core and FST for the Lower Body, and serves as the sequel to their previous educational program, Optimal Shoulder Performance. FST for the Upper Body is perfect as a stand alone program, but also builds off Optimal Shoulder Performance to help take your knowledge to the next level. Putting the information from all of these products together will give you a complete understanding of how we approach our integration of rehabilitation and performance.

We had great reviews from the live filming of this program:

Special Sale Price This Week Only

Functional Stability Training for the Upper Body is available now and is on sale for $20 off to celebrate the launch.

If you haven’t purchased any of the other FST products in the past, you can get all three FST programs for the Upper Body, Core, and Lower Body together in one bundle and save another $20.

These special sale prices are for this week only and end Sunday May 18th at midnight EST. Click below to learn more and order before this sale price ends!

I’ve recently been playing around with a variation of the yoga push up on an unstable surface. The yoga push up exercise integrates a push up with a plus with the downward dog yoga position. You can also perform this exercise on an unstable surface, such as a stability ball.

How to Perform the Yoga Stability Push Up

Here are a few of my coaching cues during the yoga stability push up:

Place the stability ball up against a wall. The instability provided the ball is plenty, having the ball mobile isn’t needed and may not be safe. Also, don’t perform this on turf as it is sometimes hard to keep the feet from slipping.

Start at the beginning plank position at the top of the push up. In this position prep you body by finding neutral spine and performing a mild abdominal brace. Keeping the core stable with enhance the mobility benefits at both the shoulders and hips.

Perform a push up but on the push back up focus on your hands pushing up and out above your head to drive your hips up high. Protract your shoulders to perform a “push up with a plus.” Be sure to keep your core stable and hinge at your hips. You should feel both your abdominal area and glutes engage.

Benefits of the Yoga Stability Push Up

There are many benefits of incorporating the yoga stability push up into your routine. The three big things I am looking to improve with this exercise are:

Serratus anterior activity. The push up with a plus includes both upward rotation and protraction of the scapula, the two motions of the serratus anterior that when performing together have been shown to enhance serratus activity.

Hip mobility. By adding the downward dog yoga hip hinge portion of the exercise, you drive more elevation of the arms, but also help facilitate a hip hinge pattern.

The latest Inner Circle webinar recording on the Strategies for Anterior Pelvic Tilt is now available.

Strategis for Anterior Pelvic Tilt

This month’s Inner Circle webinar was on Strategies for Anterior Pelvic Tilt. I go through my system of how I integrate manual therapy, self-myofascial release, stretching, and correcting exercises. To me, it’s all how you put the program together. My system builds off each step to maximize the effectiveness of your programs.

To access the webinar, please be sure you are logged in and are a member 0f the Inner Circle program.

A common component of any shoulder or neck evaluation is observation of scapular position and motion. Posture assessment is popular and attempts to identify any asymmetries between sides.

As our understanding of the mechanics of the shoulder and scapular improve, the reliability and validity of assessing resting scapular position have recently been challenged. Many authors believe that we may be overassessing and assuming dysfunction based on resting scapular position, which would imply that many corrective exercise strategies for the scapula may be either ineffective or inappropriate.

I have really changed how I assess and treat scapular dysfunction over the last decade. My research has led my change in thought process, but other studies have also been reported in the literature.

Does Poor Scapular Position Correlate to Poor Scapular Mobility?

My exploration of scapular asymmetries and dyskinesis led me to first assess scapular position. In baseball players, asymmetries of scapular position are common, and perhaps a normal adaptation.

While these resting static asymmetries were noted, I started to observe that these asymmetries seemed to become much less obvious during active movement. As an example of this, we noted that the resting static position of the scapula on the throwing side was 14mm lower, which was statistically significant. However, when the arms were abducted in the scapular plane to 90 degrees of elevation, the scapula was now symmetrical with the nonthrowing shoulder.

This really made me start thinking about the validity of resting static scapular posture.

Several studies have shown that these scapular asymmetries are common in the general population too, so I consider my findings in the overhead athlete relevant to any population. In my experience these same results occur in other populations.

Does Scapular Position Correlate to Injury?

The validity of static resting posture of the scapula has come into recent debate as tests such as the Lateral Scapular Slide Test, described by Kibler, has been shown to find asymmetries in both symptomatic and asymptomatic people. Static postural tests like this have been shown to have both poor reliability and validity, meaning that we are not sure how accurate they are or what these tests actually measure.

in a 2-year prospective study of over 100 recreational athletes, a recent study in the International Journal of Sports Medicine showed that static resting scapular position did not correlate to the future occurrence of shoulder pain. They did note that the people who developed shoulder pain demonstrated decreased scapular upward rotation at 45 and 90 degrees of elevation, further suggesting that dynamic mobility is more important that static.

These studies are difficult to conduct but it appears that scapular asymmetries are common in the general population and do not correlate to injury. That does not necessarily mean they do not feed into dysfunction, but the correlation may not be as factual as many think.

Recommendations

So what do we know about resting scapular position?

Based on our current understanding of scapular posture, it is hard to place a lot of emphasis on static posture as it does not appear to be reliable, valid, correlate to injury, or correlate to poor movement patterns.

I think one of the worst things you can do is assume dysfunctional movement will occur based on a posture assessment. For example, you would not want to cue excessive scapular movement during arm elevation just because the person is resting in a certain scapular position. You have a very large chance of just further facilitating your compensatory pattern by forcing the motion instead of finding the underlying cause.

People often seem to forget one VERY important fact:

The scapula is part of the scapulothorax joint. The position of the thorax and spine will greatly influence the position of the scapula. [Click to Tweet]

Perhaps an anterior pelvic tilt is causing increased thoracic kyphosis and scapular anterior tilt. Perhaps a forward head posture is causing shortness of the levator scapula and causing downward rotation of the scapula. Cueing movement without addressing the alignment, soft tissue restrictions, and other real issues is going to make this a lot worse.

These are just two examples but hopefully demonstrate the complexity of assessing scapular position and mobility.

Do I still look at posture and scapular position? Sure. I start there, but realize that dynamic movement is likely much more important to assess. I would not recommend that you apply corrective exercises based solely on resting scapular position.

I was having a conversation recently with one of the big league baseball pitchers that I work with in the offseason that I thought would be worth sharing. As we were working on his arm care program and laying out the start of his long toss program, we started to discuss how far he should attempt to throw. In the past, he had only thrown to somewhere in the 120-180 foot range (kids, take note of this, you can make it to the big leagues by only throwing to 180 feet in the offseason…), but he had been hearing about all the trendy long toss programs that have you throw to 300+ feet.

My reply was a less than convincing, “it depends,” as I strongly feel the need to individualize each pitcher’s programs. However, I casually reminded him that he threw pretty hard and was already in Major League Baseball. Not just professional baseball, but he is actually a big leaguer.

“Sure, I throw hard, but what if I could throw harder,” was his response! I agreed, but stated “OK, but at what consequence.”

The Minimum Viable Product

This led us to the concept of the “minimum viable product.”

Those in the business world have surely heard of the concept of the “minimum viable product.” A minimum viable product is a product with the least amount of features that can be released. Think of it as a bare bones product. In the lean manufacturing business model, this minimum viable product approach has numerous advantages that center around the concept of assessing the product and making adjustments along the way rather than making a huge gamble and finding out you were off base. If you put all your eggs in one basket and the product fails, you are in trouble as you have put considerable time, energy, and money into this product.

In the business world this could be the difference between succeeding and going out of business.

In our world, this could be the difference between enhancing performance and creating an injury.

The Minimum Viable Exercise

This is where the “minimum viable exercise” comes into play. A minimum viable exercises is an exercises that is the least intensive that still elicits the desired effect. Ok, yes, I just made that up, but that is how I would define minimum viable exercise.

To enhance performance and minimize injury, select an exercise that is the least intensive that still elicits the desired training effect. [Click to Tweet]

Using long toss as the “exercise” example and velocity as our desired “effect,” I would want you to throw as far as you need to increase velocity, and no more. It isn’t always a “more is better” approach. I can’t help but think of the classic Jerry Seinfeld joke about maximum strength medications where he states “Give me the maximum strength. Figure out what will kill me and then back it off a little bit.”

This concept also applies to throwing with weighted balls, but I would say applies even more to throwing all year round. Many baseball coaches feel that taking time off from throwing in the offseason is a missed opportunity to improve, despite statistical research showing that injuries increased 5x by pitching for more than 8 months out of the year! We are often times too far along towards the “maximum strength exercise” rather than the “minimum viable exercise.”

When it comes to our original discussion about long toss distance, there are two ways of implementing. One would be to simply jump into a long toss program to 300+ feet with the hope of increasing velocity (and not getting injured). The minimal viable exercise approach would slowly and gradually extend the distance and then reassess.

Did velocity go up? Could you perform long tossing at that distance with proper mechanics? Are there any signs that your body can not handle the stress observed at that distance? Based on this information you can make an accurate adjustment before it is too late, either continue to progress, back down, or be content with your progress and maintain.

The flip side of this is the young athlete that I commonly see that broke down from jumping too fast and performing for the “maximum strength” exercise. The fine line between risk and reward is razor thin at this point.

You can apply the minimum viable exercise to any aspect of rehabilitation, fitness, and performance training, not just baseball. I’m just using this in the context of our conversation. However, I think this minimum viable exercise concept is already being perform more than we may realize. Imagine you are trying to increase your deadlift, you wouldn’t make a huge jump in weight and risk performing your lift with bad form or getting injured. Rather, you would make smaller and more gradual gains, then assess and adjust.

Don’t get me wrong, I am not saying don’t push yourself. Rather, push yourself but in an intelligent and systematic way.

Don’t get greedy and jump to the maximum strength exercise. Build intelligent programs that assess and adjust on the way. This is the minimum viable exercise.

I am always a fan of simple exercises that get a big bang for my buck. I want to be able to streamline my programs to have as little fluff as possible.

One exercise I often use for scapular control is called the “cheerleader exercise,” which my friend Russ Paine in Houston first showed me and has popularized over the years. Russ included this exercise in one of his latest publications on The Role of the Scapula in the International Journal of Sports Physical Therapy. The article is free to read and is a great adjunct to my recent webinar on Scapular Dyskinesis.

Russ teamed up with another pioneer in sports physical therapy, Mike Voight, to write the new manuscript. The amazing part is that Russ and Mike wrote one of the landmark articles on scapular rehabilitation in JOSPT in 1993, twenty years ago!

The cheerleader exercise uses a piece of Theraband or rubber tubing to perform a series of reciprocal exercises focusing on scapular retraction. You begin by grasping a piece of tubing between both hands with your arms raised forward at shoulder height. Pull both hands apart into horizontal abduction. Then, return to the starting position and pull one arm down and the other up in a diagonal pattern. For those familiar with proprioceptive neuromuscular facilitation (PNF) drills, these are D2 flexion and D1 extension positions. Return to the starting position again and switch the diagonals.

This is a great posterior chain drill that works on developing strength and endurance in a functional scapular patterns. It is a great drill when working on facilitating a more posterior dominant posture, and getting out of our terrible anterior dominant sitting posture.

This one drill effectively combines several exercises that focus on scapular retraction, upward rotation, and posterior tilt. But what I really like about the exercise is the reciprocal nature of the exercise.

I don’t use this as a replacement for pure isotonic strengthening of the scapula muscles, such as the YTWL exercises, but it is a nice drill to work on integrated patterns and endurance. Next time you are looking for a drill to enhance scapular control, posterior chain strength, and postural awareness, try the cheerleader exercise.

Work with Mike Reinold

Mike is the President and Co-Founder of Champion Physical Therapy and Performance, located in Boston, MA. Champion offers an integrated approach to elite level physical therapy, personal training, and sports performance.

Click below to learn more about seeing Mike and his team for 1x consultations or ongoing physical therapy, personal training, or sports performance training: